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UPDATE: SPECIALTY CREDNETIALING "Certificates of Added Qualification" Replace "Specialty Certification"
At its July 31 meeting, the NCCPA Board of Directors voted to change the name of the organization's new specialty credential program from "specialty certification" to a certificate of added qualifications (CAQ) program.
Mark Christiansen, PhD, PA-C, who chairs the NCCPA committee spearheading the development of the new specialty program, notes that the new CAQ label has several benefits.
"A certificate of added qualifications clearly reflects its relationship to the PA-C credential. This is a designation that PAs earn above and beyond the PA-C, which remains the foundational credential for the PA profession," says Christiansen. "The certificate of added qualifications name also appropriately reflects PAs' grounding first in primary care or generalist practice, a base of training and knowledge that is augmented but not replaced through practice in a specialty."
The change also stemmed from concerns that a program labeled "certification" would trigger automatic credentialing and privileging requirements in many hospital settings, an issue that runs counter to its positioning by NCCPA as a voluntary process.
"Learning that many hospital credentialing forms specifically ask whether there is 'certification' available in a practitioner's specialty area prompted us to reconsider that label," Christiansen says. "We hope PAs practicing in specialties will choose to participate in this new program, but we don't want it to be forced on them just because of what we've chosen to call it."
Adds NCCPA President Janet J. Lathrop, "The challenge of appropriately incorporating specialty practice in the PA certification process is probably the biggest--and certainly the longest running--challenge NCCPA has faced in our 35-year history. It's rewarding to resolve it while appropriately addressing our responsibility to the public and the needs and concerns of the PA profession."
Registration for the new CAQ process is scheduled to begin in November. The program will include CAQs in cardiovascular/thoracic surgery, emergency medicine, nephrology, orthopaedic surgery and psychiatry. The first specialty exams will be administered in September 2011.
CAQ Program Requirements, Fees Announced
Those who have been waiting for more details about what will be required of those interested in pursuing NCCPA's new specialty credential need wait no longer; at its July 31 meeting, the NCCPA Board of Directors reached decisions on all of the remaining details, approving policies now available at http://www.nccpa.net/SpecialtyCAQs.aspx.
As previously reported, PAs seeking a CAQ must be currently certified by NCCPA and must have valid, unrestricted licenses in all jurisdictions in which they are licensed (or unrestricted privileges to practice as a PA for a government agency). Applicants must also have 2,000 to 4,000 hours (one to two years of full-time experience) in the specialty, must meet specialty CME requirements (now 150 hours of specialty CME, hours that may also be applied toward PA-C maintenance requirements), and must satisfy requirements in the area of procedures and/or patient case management. The newly-approved policies provide more specifics on each area.
The Board also established fees for the new CAQ process, including a $100 administrative fee, payable upon the submission of the first requirement, and a $250 examination fee, payable with the application for a specialty exam.
"We hope that PAs are pleasantly surprised at the cost of the new CAQ program," says Treasurer James Cannon, DHA, MBA, PA-C. "The fees are low because of determination on the part of NCCPA's Board and management to re-examine the plan and process for this new program again and again and again, thinking creatively about ways to administer this program as economically as possible. Considering that comparable programs cost more than $1,000 in other professions, I'm personally very proud that our commitment to good stewardship has produced such a high quality but affordable CAQ process for PAs."
One of the cost-saving measures was the decision to limit the specialty exams to one day a year, minimizing exam development and administration costs.
"We're sacrificing some convenience for cost-savings, but that was a trade-off we felt PAs would understand and appreciate," says Cannon.
Registration for the new CAQ process is scheduled to begin in November. The program will include CAQs in cardiovascular/cardiothoracic surgery, emergency medicine, nephrology, orthopaedic surgery and psychiatry. The first specialty exams will be administered in September 2011.
Call for ClinQI Pilot Project Volunteers
Earlier this summer, NCCPA announced plans to conduct a pilot project to further inform discussions about the potential addition of clinical quality improvement projects (ClinQI) to a new maintenance of certification (MOC) process for PAs. (For the full story on the potential MOC changes from earlier this summer, click here.) NCCPA is considering the integration of ClinQI into the MOC process in support of competencies in the area of Practice-Based Learning and Improvement.
The goals of the ClinQI Pilot Project are three-fold:
1. Gain a better understanding of how the ClinQI project will work for PAs in a wide range of practice settings, specialties, etc. (including those who are not in full-time clinical practice).
2. Gather more information about the time investment involved, barriers to the ClinQI process and factors that contribute to the success of ClinQI projects.
3. Assemble a collection of documented ClinQI projects that can serve as examples to others.
The ClinQI Pilot Project will begin this fall. Participants will be asked to complete the project of their choice and design by May 1, 2011. We are seeking a broad range of participants, including those with and without prior experience with ClinQI. If you are interested in participating in the pilot project, click here to complete a short survey to provide us more information about you, your practice, and your experience with ClinQI.
Still trying to understand what ClinQI is? Here's how we're describing it for purposes of the pilot project:
"ClinQI projects connect PAs with their supervising physician and/or other members of the health care team to engage in the design, implementation and review of a quality improvement initiative. This project could take many forms. For example, PAs could identify a particular subset of patients and devise and implement a plan to improve a key health indicator or to increase their adherence to a treatment plan. PAs could devise a plan to identify patients who are at-risk for a particular condition earlier or to improve the practice's capacity to serve its patient population. Again, those are just a few examples.
Most Board-certified physicians are now required to participate in a similar process to maintain their own certification. PAs would be encouraged to partner with their supervising physicians whenever possible so that together the team can satisfy requirements of both certifying bodies with a single project. Other PAs may already be engaging in QI projects in their workplace; those QI activities could be used to satisfy the ClinQI requirement for the MOC process."
August is National Psoriasis Awareness Month
What is psoriasis? Psoriasis is a common chronic condition that causes thick red marks and flaky white patches What causes psoriasis? Psoriasis starts with the immune system. Your immune system usually protects the body against infection and disease by attacking bacteria and viruses. However, when you have psoriasis, your T cells, a kind of white blood cells that are part of the immune system, mistakenly attack your skin cells instead. Your body then produces other immune system responses, leading to swelling and rapid production of skin cells. Psoriasis tends to run in families and it usually appears between 10 and 45 years of age.
People who have psoriasis may experience periods of time without any symptoms. Other times, psoriasis will "flare up" (get worse). Certain things that can cause the psoriasis to get worse include: - Infections (such as strep throat and the common cold)
- Diseases that weaken the immune system
- Stress
- Certain medicines (such as beta-blockers for high blood pressure and drugs used to prevent malaria)
- Skin irritations
- Cold weather
- Smoking
What are the symptoms of psoriasis? The symptoms of psoriasis may include: - Pink or red, raised patches of scaly skin
- Dry, cracked or flaky skin (it may also bleed at times)
- Skin that burns, is itchy or sore
- Thick, pitted fingernails
- Pus-filled blisters on the red patches of skin (in more severe cases)
The symptoms most often appear on the skin of the knees and elbows, although psoriasis may occur anywhere on the body (including the scalp, palms of the hands, soles of the feet, mouth and skin on the joints).
Is psoriasis contagious? No, you cannot catch psoriasis from another person or give it to someone by touching them. You also cannot spread it to other parts of your body.
How is psoriasis treated? There are a number of treatments for psoriasis. Your doctor will help you decide which one is best for you. Keeping your skin moisturized with an over-the-counter product is a good first step. Body lotion can help keep skin from getting too dry and cracking. It can also help remove some of the scales. Bathing daily in Epsom salts, Dead Sea salts, bath oil or oatmeal can calm redness and remove scales.
Prescription creams, ointments, lotions and gels (also called topical medicines) that you put on the affected areas are often used to treat psoriasis. To help the medicine stay on the skin, you might apply it and then cover the areas with plastic wrap (such as Saran Wrap). Options include corticosteroids, a type of vitamin D and pine tar. Special shampoos are used for psoriasis on the scalp.
For more severe cases of psoriasis, your doctor may prescribe antibiotics or other medicines in pill form. Some of these medicines can cause side effects, so your doctor may prescribe these for only a short period of time before returning to another type of treatment.
Sunlight also can help psoriasis, but be careful not to stay in the sun too long. A sunburn can actually make your psoriasis worse. Talk to your doctor about how to safely try sunlight exposure as a psoriasis treatment. Light therapy may be another option for treatment of psoriasis. With this treatment, the affected skin is exposed to controlled forms of artificial sunlight, usually after using Psoralen, a light-sensitizing medicine. This is called "PUVA" treatment.
Will psoriasis go away with treatment? While psoriasis will typically improve with treatment, it may not ever completely go away. The scales of psoriasis should improve after you begin treatment. It may take 2 to 6 weeks for the affected areas of your skin to return to a more normal thickness, and the redness may take several months to improve. Sometimes, certain scaly spots will get better at the same time that other spots get worse.
After you've been using a certain type of medicine for a while, your psoriasis may "get used to" the treatment. If this happens, your medicine may not be as effective as it once was. Your doctor may change your medicine. Sometimes you may need a stronger dose of medicine. Talk to your doctor if your psoriasis doesn't seem to be getting better with treatment.
Other Organizations Source Written by familydoctor.org editorial staff. American Academy of Family Physicians Reviewed/Updated: 07/10 Statistics PrevalencePsoriasis is the most prevalent autoimmune diseases in the U.S. According to the National Institutes of Health (NIH), as many as 7.5 million Americans—approximately 2.2 percent of the population--have psoriasis. 125 million people worldwide—2 to 3 percent of the total population—have psoriasis. Studies show that between 10 and 30 percent of people with psoriasis also develop psoriatic arthritis. Psoriasis prevalence in African Americans is 1.3 percent compared to 2.5 percent of Caucasians.1
Quality of lifePsoriasis is not a cosmetic problem. Nearly 60 percent of people with psoriasis reported their disease to be a large problem in their everyday life.2 Nearly 40 percent with psoriatic arthritis reported their disease to be a large problem in everyday life.3 Patients with moderate to severe psoriasis experienced a greater negative impact on their quality of life.4 Psoriasis has a greater impact on quality of life in women and younger patients.4
Age of onsetPsoriasis often appears between the ages of 15 and 25, but can develop at any age. Psoriatic arthritis usually develops between the ages of 30 and 50, but can develop at any age.
Severity of psoriasisThe National Psoriasis Foundation defines mild psoriasis as affecting less than 3 percent of the body; 3 percent to 10 percent is considered moderate; more than 10 percent is considered severe. For most individuals, the palm of the hand is about the same as 1 percent of the skin surface. However, the severity of psoriasis is also measured by how psoriasis affects a person's quality of life. Nearly one-quarter of people with psoriasis have cases that are considered moderate to severe.
Cost of psoriasisGenetic aspects of psoriasisAbout one out of three people with psoriasis report having a relative with psoriasis. If one parent has psoriasis, a child has about a 10 percent chance of having psoriasis. If both parents have psoriasis, a child has approximately a 50 percent chance of developing the disease.
| | | |  Posted 7/28/10
by Marya Zilberberg, MD, MPH Much like many other news items, I came upon the one about the proposed name change for Physician Assistants quite by accident: it came to me as an e-mail notification of a new topic being discussed on one of the physician only discussion boards that I am a part of. Apparently, after 40+ years of the profession’s existence, there is a grassroots effort afoot to upgrade the name, and presumably the clout, to Physician Associate. Well, as you can imagine, while the move is met with praise by the PA profession, the MD profession is seething. Some of the comments that I have seen from my colleagues betray such tremendous pain and suffering as a profession that it threatens my equanimity: I feel organically how lost we are as a profession to be expressing such bile without much thought over what appears to be a relatively innocuous event. But surprised I am not, and here is why. The medical profession’s victory over all other potential modalities is hard-won and filled with a history of major turf battles and occasional demagoguery. The historically either-or approach of modern-day practice of medicine is responsible for the current landscape of our healthcare. In short, physicians have been only too successful at becoming the final word in health, at the exclusion of all others. With the allied providers, such as nurse practitioners and PAs, gaining in importance, particularly at this time of great uncertainty about the future of our healthcare “system”, understandably the MDs are reflexively bracing themselves for any and all turf battles. So, the perception of a power grab that this proposed name change has engendered in my hallowed profession is a classic fight-or-flight response, an activation of the survival instinct. There are several aspects of this response that I find disturbing. At the most basic level, the response betrays such tremendous emotional pain among so many good people that it is all I can do to keep myself from sinking into a depression. And while I feel compassion for them, I am also forced to remind them that, as Eleanor Roosevelt once said, “No one can make you feel inferior without your consent.” Applying the thought to the current situation, how the society may view PAs, whether they are called assistants or associates, should have absolutely no bearing on how physicians are perceived. Simply put, this perceived elevation in the status of the PAs relative to that of the MDs should not in any way make the MD profession diminish in its or the public’s view. The next layer of why this is a dysfunctional response lies in a poor choice of battles that this represents. I once had a boss, whom, despite working for myself currently, I frequently allude to as “the best boss I have ever had.” When I would get hot under the collar, she would pointedly ask me to clarify for myself whether this was an issue to fall on my dagger for, thus teaching me that falling on my dagger too many times would make me politically into Swiss cheese, or, worse yet, dead. Under the circumstances, do MDs and their organizations really feel that this is an important dagger to fall on? In the current atmosphere of public distrust rightly or wrongly bestowed upon the profession, such indiscriminate issue picking will rightfully appear self-serving. Finally, for a profession with, on average, a very high intelligence quotient, I am amazed that we are focusing on the minutia instead of looking at the big picture. Healthcare is a behemoth, an inefficient and inequitable trough at which there has been a feeding frenzy for too long. We need to be reining it in to the best of our abilities. And yes, altruism, not unmitigated self-interest should be driving us to do this. Gentleness toward and respect for each other, our communities and our planet should be the values that determine our actions as a profession. I am convinced that these are the values that brought us into medicine. These are difficult times, made more so by the external forces all ganging up to deprive us of our humanity. Let’s get back to the reasons why we went into medicine; let’s sit quietly and find that lost thread of contentment and pride. Or else, if there is no joy left for you in your practice, resolve to find something else that you can be happy about. And no, it is not easier said than done. It is much more difficult to go through life carrying the baggage of self-imposed misery than to set it down in favor of finding happiness in this brief sojourn that is our life. Marya Zilberberg is founder and CEO of EviMed Research Group and blogs at Healthcare, etc. From "O Magazine" by Oprah Winfrey - March 2009 Issue
New Kinds of Primary Care By Lauren Dzubow  Photo: © 2009 Jupiterimages Corporation
Physician Assistant (PA)
What it is: A licensed clinician who has completed at least a two-year accredited program—think of a truncated MD education—and practices under the supervision of a physician. PAs are not required to complete internships or residencies; many focus their studies on primary care medicine.
The reason: The PA role began in the mid-1960s in response to a shortage of PCPs in underserved and rural areas. One doctor's office can employ several physician assistants to act as principal care providers, per the guidance of the supervising physician.
The benefit: Physician assistants are often available for appointments when physicians aren't, and you won't be sacrificing quality of care, suggests a recent Duke University study. This care can include conducting physical exams, diagnosing and treating illnesses, ordering and interpreting tests, counseling on preventive care, writing prescriptions, and assisting in surgery.
Where to find one: At a doctor's office: About 35 percent of PAs work in primary care, the rest in medical and surgical specialties, according to the American Academy of Physicians Assistants. There are almost 74,000 PAs today, compared with 240 in 1970. The U.S. Bureau of Labor Statistics estimates that the number of PA jobs will increase by 27 percent between 2006 and 2016.
Nurse Practitioner (NP)
What it is: A registered nurse who has also completed graduate-level medical education. For most, this has meant getting a master's degree, but more and more NPs are advancing to a Doctor of Nursing Practice, which can take two to four more years of study.
The reason: Like PAs, nurse practitioners helped fill the PCP shortage in the mid-'60s. NPs can function as primary care providers, no supervision required, says Mary Jo Goolsby, EdD, director of research and education at the American Academy of Nurse Practitioners.
The benefit: Studies have found that NPs can provide care that matches and at times improves on that of doctors while still being cost-effective: NPs emphasize prevention and spend an average of 21 minutes with a patient, longer than a typical doctor visit, says Goolsby. "We're not using a shotgun approach and ordering unnecessary tests. We focus on the patient and help her learn to take care of herself, so she may avoid future complications."
Where to find one: Check your local directory or visit NPFinder.com, a service provided by the American Academy of Nurse Practitioners. About 67 percent of NPs are in primary care, and they may work independently or in collaboration with a physician, depending on state regulations. The field is rapidly growing: There are more than 125,000 NPs today, 44 years after the first NP program was developed in 1965.
Hospitalist
What it is: A physician who manages a patient's care in the hospital until she has been discharged. Most hospitalists have a Doctor of Medicine or a Doctor of Osteopathic Medicine degree; the majority are trained in internal medicine or pediatrics.
The reason: A hospitalist makes it unnecessary for a PCP to visit hospitalized patients, says Patrick Cawley, MD, president of the Society of Hospital Medicine. It also means a hospital patient will have an in-house point person to oversee the care she receives from nurses, surgeons, and specialists.
The benefit: Hospitalists are available around the clock, and are intimately familiar with the hospital environment. This can translate to a reduction in length of stay—and expense—by an average of 15 percent. And research shows that hospitalists provide a standard of care that matches or surpasses that provided by PCPs. In fact, a few studies indicate lower mortality and readmission rates in hospitalist programs.
Where to find one: Once you've checked in to a hospital, they'll come to you. (You can call local facilities to see if they employ these doctors.) Hospitalists monitor and coordinate all aspects of your care—about the only thing they don't do is perform surgery. According to a recent study, this is the fastest-growing medical specialty in U.S. history; more than 22,000 are practicing today.
Link to "O" Magazine online: http://www.oprah.com/article/omagazine/200903_omag_primary_care NCCPA WILL BEGIN SPECIALTY EXAMSKudos to Advance for PAs.
Public Statement Regarding NCCPA’s Commitment to Offer a Voluntary Credential for PAs Practicing in Specialties After several years of thoughtful consideration of how to best serve the public interest and discussions with numerous PA and physician specialty organizations and others, at a February 8, 2009 meeting, NCCPA’s Board of Directors reaffirmed its commitment to offering a mechanism for the achievement of a voluntary PA specialty credential. An NCCPA workgroup is developing the model for a specialty credential program, which the organization will launch no later than 2011. As the model develops, NCCPA will continue to work with AAPA and physician and PA specialty organizations in the discussions. NCCPA is committed to engaging others in dialogue about the specific elements of the specialty credential program and to considering their input. Written comments can be submitted to NCCPA by email and should be directed to
This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
. National Provider Identifier (NPI) The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans/ health care clearinghouses will use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty. PAs are encouraged to review their data that is listed on the NPI directory to make sure it is correct: https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do
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